Abstract
BackgroundPosttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD.MethodsEligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist–Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership.ResultsFour distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support.ConclusionsComorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.
Highlights
Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, major depressive disorder (MDD)
Despite the prevalence of comorbid PTSD and MDD, and the deleterious outcomes related to this comorbidity, little is known about how these symptoms fluctuate concurrently over time and what factors are associated with comorbid symptom trajectories
Four distinct classes of probable comorbid PTSD/MDD were identified among service members and veterans, which illustrate how these comorbid symptoms move in relation to one another over time
Summary
Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD. Previous studies have found fewer than 20% of service members categorized in all other trajectories combined [19,20,21] Results from these previous studies, which include such a large proportion of resilient individuals, may mask important heterogeneity among individuals with high symptomatology. In these studies, typically only one trajectory includes individuals with high symptomology at baseline. The current study aimed to fill this knowledge gap by identifying comorbid symptom trajectory classes among a representative sample of service members and veterans with probable comorbid PTSD and MDD. A second objective of this study is to determine factors predictive of symptom trajectories to be able to identify those who may have a more persistent course of symptoms potentially warranting further intervention
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